Background Some rheumatoid arthritis (RA) patients considered in clinical remission undergo structural and functional worsening, due to residual subclinical inflammation 1. However, it is unknown if traditional DMARDs and biological agents present different efficacy in inducing complete suppression of inflammation as determined by ultrasound (US).
Objectives To determine the prevalence of ultrasound (US) detected synovitis in RA patients presenting a clinical sustained remission treated with traditional DMARDs or biological agents, and compare the US findings of both groups of treatment.
Methods Seventy-seven RA patients (ACR1987 and ACR/EULAR 2010 criteria), in regular follow-up at the Rheumatology Departments of Universita Politecnica delle Marche (Italy) and Universidade de Sao Paulo (Brazil), considered in clinical sustained remission (DAS 28 criteria <2.6 for at least 6 months), were enrolled. All the patients underwent clinical examination followed by US examination of hands (metacarpophalangeal joints) and feet (metatarsofalangeal joints). Moreover laboratory data were collected.US examinations were performed by two experienced rheumatologist sonographers, using a MyLab Twice and 70 XVG (Esaote S.p.A) equipped with 6-18 MHz broad band multi-frequency linear transducer. Joint cavity widening (JCW), due to synovial effusion or synovial hyperthrophy, and intra-articular power Doppler (PD) signal were investigated at metacarpophalangeal joints (from 2th to 5th), wrist and metatarsophalangeal joints (from 2th to 5th). For the interpretation of the US findings the OMERACT preliminary criteria were adopted. JCW and intra-articular PD were graded based on semiquantitative scoring systems: none, mild, moderate and severe (0 to 3).
Results A total of 1540 joints were examined; 77% of patients (without symptoms and clinical detectable arthritis) presented one (39%) or more joints (2-5=54%, >5=7%) with greyscale synovial hypertrophy. Futhermore, 44% of all patients presented increased PD sign in at least one (50%) or more (2-5=47%, >5=3%) joints. Eleven patients from the 24 under biological therapy, and 23 patients from the 53 under DMARDs presented PD sign in at least one joint, with no significant difference among both groups (p=0.8).
Conclusions Our study demonstrates that a high number of RA patients under DMARDs and biological agents considered in clinical remission presented active synovitis detected by US. This finding strengthens the importance of imaging assessment in order to obtain an accurate definition of disease status. Unexpectedly, US outcome was similar in patients receiving traditional DMARDs or biological agents.
Brown AK, et al Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum. 2006 Dec;54(12):3761-73.
Disclosure of Interest None Declared
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